Last month I attended an event honoring StateRepresentative Dean Arp (R-Union). Rep. Arp serves as Chairman of the House Appropriations Committee, the committee responsible for crafting North Carolina’s state budget. Chairman Arp will be critical in allocating sufficient funds to the Medicaid budget for the increases we are seeking this legislative session. During the event we discussed the importance of getting the rates up prior to Medicaid’s transition to managed care, which is targeted for July 2019. In addition to supporting our issues in the past, Rep. Arp has been on a home visit and understands the importance of home care in the continuum.

With Sen. Tucker’s recent retirement announcement, it is critical we have allies in the Senate to help carry our message as well. Senator Joyce Krawiec is next in line. To educate her on our issues, we are in the process of identifying a client in her district to host a home visit early in 2018.

Last month the GAO Advisory Committee met to evaluate our 2017 efforts and to plan for 2018. The Advisory Committee is made up of representation of every practice in NC as well as representation from CMO and GAO. Below is a summary of their findings and the priorities for 2018.

2017 Legislative Accomplishments
With your help we accomplished the following:

• Secured an increase for Medicaid aide services under the Personal Care Services (PCS) Program and the Community Alternatives Program for Children (CAP-C) from $13.88 to $15.52, effective August 1, 2017, and to $15.60 effective January 1, 2018. BAYADA impact: $300K annually. These increases will allow us to hire and retain more quality staff.
• Protected Certificate of Need (CON) and prevented its elimination from health care. Also prevented the Continuing Care Retirement Communities (CCRCs) from operating a home health agency without a CON. The CCRCs were seeking a carve-out from CON statute. Four separate bills were filed to eliminate this statute. BAYADA impact: Protected 5 service offices that serve Medicare clients. This issue is likely to re-surface in 2018.
• Secured a 7.5% tax exclusion for health care services on all revenue.
BAYADA impact: All 54 NC service offices will save a collective $12.6M annually.

2018 Key Legislative Priorities:

• Amend the Community Alternatives Program for Disabled Adults (CAP-DA) budget neutrality language to allow the aide rate to be increased from $13.88 to $15.60 to align with the PCS and CAP-C rate increases effective Oct. 1, 2018, by Q4-2018.
• Secure a $1.40 increase for all Medicaid aide services from $15.60 to $17.00 effective Jan. 1, 2019, by Q3-2018.
• Prevent the elimination of Certificate of Need (CON) for home health or hospice by Q3-2018.
• Ensure that the Medicaid Transformation waiver includes a rate floor provision and language that ensures access to quality care and minimal administrative burden by Q4-2018.

Often we talk about sharing our message, making our point, and communicating our value proposition. Those are things we, in the Government Affairs Office (GAO), must do as we seek support for our issues with lawmakers. One such conversation was had with Representative Nelson Dollar earlier last week, where Chief Government Affairs Officer Dave Totaro and I thanked him for his past support on the rate increases and continued our conversation around our priorities for the year to come.

If we are to continue to be successful in building a strong advocacy base, it is not enough to build relationships with lawmakers. We must also get to know our internal BAYADA customers–our staff and clients. As such, we visited six home health offices on the I-85 corridor. It was great to be able to provide a legislative update, share advocacy information, and solicit feedback. It helps ground our efforts and put things into perspective.

Special thanks to Division Director Richard Hopson, Area Director Shad Morgheim, and the office directors for allowing us to visit. We really enjoyed visiting with staff at CV, CHF, GAV, CAV, SC, DAV, RV, and DRF.

Last week, North Carolina’s Department of Health and Human Services (DHHS) released two requests for information (RFI) as their next step towards Medicaid Managed Care. Both requests, statement of interest and financial operations, focus on the organizations that intend to bid to be a pre-paid health plan (PHP) for Medicaid. “This RFI is an important step toward implementing the proposed program design that DHHS released in August,” said DHHS Assistant Secretary for Medicaid Transformation Jay Ludlam. “We look forward to continued input and collaboration from health care providers, health plans, and other stakeholders as we build the strongest possible Medicaid program for North Carolina.” Comments are due to DHHS on November 22. Our BAYADA workgroup’s next opportunity to provide input is on the proposed 1115 Waiver application, which is slated to be released at the end of this year or early 2018.

Legislative successes, like the Medicaid rate increase for nursing last year and the home health aide increase this year, don’t magically happen. Legislative successes start with an identified need — low Medicaid rates made it impossible to pay people what they are worth — and end with legislators supporting jobs in the community and keeping families together by investing in home health care. Every step along the way, our Hearts for Home Care ambassadors carried our unified message to decision-makers. Our cumulative actions over the years, including home and district visits, legislative round tables with lawmakers, responding to calls to action, attending lobby days, etc., made all the difference. Individually and collectively our shared voices got results. Join us to be a Heart for Home Care ambassador.

Ten months into her new job Secretary of Health & Human Services, Dr. Mandy Cohen has been working to move her Medicaid Transformation plan forward. She hired an implementation guru from Missouri, Jay Ludlam as the Assistant Secretary for Medicaid Transformation to lead the process. Medicaid’s hope is to address the physical and behavioral health of North Carolinians. The goal is to improve overall health by creating an innovative and well-coordinated Managed Care environment that addressed the whole-person. The program design calls for three state-wide commercial plans and up to twelve provider-led entities (PLE) as regional plans. The department’s aggressive timeline will release request for proposals (RFP) in early 2018, with a targeted transition in 2019, pending CMS approval. BAYADA has been invited to participate in stakeholder discussions as Medicaid develops their Pre-paid Health Plan (PHP) model. Our goal, related to home care, is to ensure level of services and provider adequacy remains central in the program design and waiver application. GAO has involved technical experts from across our various practices to ensure our feedback is sound and supports BAYADA’s overall mission.

NC Special Session Focuses on Redistricting. While the “Long” Legislative Session adjourned back in July, lawmakers have been called back to Raleigh twice. The General Assembly was directed by the US Supreme Court to re-draw the 28 voting districts that were found unconstitutional due to Gerrymandering. After much debate along party-lines, the redrawn maps have been sent back to the courts. If approved the new districts will be used in the 2018 elections.

Republican Sen. Tommy Tucker of Union County announced that he won’t seek a fifth term in 2018. Sen. Tucker co-chairs the influential Senate Finance Committee. “I have long believed in term limits for judges and politicians,” he said in a statement to the Charlotte Observer. “After serving four terms in the N.C. Senate, the time has come for me to allow others to step in and serve Union County and our state.”

Our relationship with Sen. Tucker started back in 2011 when Hearts for Home Care Ambassador John Morris and I visited with him in his district office to introduce him to BAYADA and home care. That visit led to a home visit where he was able to see first-hand the impact home care has on his constituent. Over the years and as he rose through the ranks, we met with Sen. Tucker numerous times, attended legislative receptions for him, as well as, visited with him at Lobby Days. His door is always open for BAYADA. He was instrumental in ensuring the CAP-C rate increase for nursing was put in the Senate’s budget and that it was ultimately passed. Sen. Tucker was BAYADA’s Legislator of the Year 2016. We thank Sen. Tucker for his commitment and support of our staff and clients. His vision and leadership will be missed.

LaToya, Jackie, Tanner, and Melissa at Legislative Day with Sen. Tucker receiving the BAYADA Legislator of the Year Award

Last week, I attended the Medical Care Advisory Council (MCAC) meeting where Jay Ludlam the new NC Department of Health and Human Services (DHHS) Assistant Secretary for Medicaid Transformation presented the department’s program design for taking Medicaid into a managed care environment. Having been on the job for less than three weeks, Ludlam said, “649 days until the Medicaid Managed Care go live date!” While many steps need to occur before “go live”, including formal approval by Centers for Medicare and Medicaid Services (CMS), the department is aggressively working towards that goal. I spoke with Mr. Ludlam after the meeting, not only to introduce BAYADA but also to express our concerns with the fast pace, and lack of details for how long-term services and supports will be incorporated into reform. As you may recall, BAYADA formed a review team and has already submitted comments to the program design. The Government Affairs Office (GAO) will continue to participate in the discussion as the state formulates its plan. Click to read Jay Ludlam’s complete bio.